21.5.1 Surgery if Deemed Suitable Candidate
21.6 Indications for Surgical Intervention
21.7 Surgical Procedure for Ventriculopleural (VLP) Shunt
Ryan F. Amidon, Christ Ordookhanian, and Paul E. Kaloostian
22.5.1 Surgery if Deemed Suitable Candidate
22.6 Indications for Surgical Intervention
22.7 Surgical Procedure for Ventriculoatrial (VA) Shunt
Contributors
Ryan F. Amidon, BS
Junior Specialist (Dr. Garret Anderson Laboratory)
Department of Neuroscience
University of California
Riverside, California, USA
Paul E. Kaloostian, MD, FAANS, FACS
Assistant Professor of Neurosurgery
University of California, Riverside
School of Medicine
Riverside, California, USA
Christ Ordookhanian, BS
MD Candidate
University of California, Riverside
School of Medicine
Riverside, California, USA
| Section ISpine | 1 Cervical2 Thoracic3 Lumbar4 Sacral5 Coccyx |
1 Cervical
Christ Ordookhanian and Paul E. Kaloostian
1.1 Trauma
1.1.1 Anterior Cervical Fusion/Posterior Cervical Fusion
Indications
• Traumatic occipitoatlantal disjointment
• No complete arch of C1
• Bursting C1 fracture (see ▶Fig. 1.1)
• Congenital abnormalities
• Odontoid movement into foramen magnum
• Vertebral shifts
Symptoms and Signs
• Stiff neck
• Sharp pinpoint pain in neck
• Soreness lasting >7 days
• Weakness in neck muscle
• Tingling/Numbness in general neck area
• Trouble gripping objects
• Tingling in finger tips
• Frequent tension headaches (~4+ days per week)
Surgical Pathology
• Traumatic brain injury (TBI)
• Traumatic injury to general neck region
– Fracture/Displacement/Compression
Surgical Procedure
1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/other anticoagulants for at least 12 days
2. Appropriate intubation and sedation
3. Horizontal skin incision 1 to 2 inches on either side of the spine
4. Split thin muscle underlying skin
Fig. 1.1 (a–c) A man suffered an incomplete cord injury after a vehicle crash. Radiology revealed that his cervical trauma was a C5 complete burst fracture. (Source: Diagnostic Features. In: Vialle L, ed. AOSpine Masters Series, Volume 5: Cervical Spine Trauma. 1st ed. Thieme; 2015).
5. Enter plane between sternocleidomastoid muscle and strap muscle
6. (Anterior) Enter into the plane between trachea/esophagus and carotid sheath
7. Dissect away thin fascia
8. Locate disk (preoperative imaging match/intraoperative fluoroscopy)
9. Remove disk by cutting annulus fibrosis and nucleus pulposus
10. Remove entire disk including cartilage endplates to reveal